Interventional cardiology for the criticalist

Abstract

The prognosis for pericardial effusion is dependent upon the underlying etiology; the prognosis for cardiac pacing is favorable, and the prognosis for caval syndrome is grave if untreated and guarded to fair if heartworm extraction is performed.

Temporary Cardiac Pacing

“…[1][2][3] Temporary cardiac pacing is also useful to support heart rate and blood pressure in patients with medically refractory chronotropic insufficiency that are undergoing general anesthesia for permanent pacemaker implantation or another surgery unrelated to the heart such as cataract extraction or cystotomy. [1][2][3] Temporary cardiac pacing is also useful to support heart rate and blood pressure in patients with medically refractory chronotropic insufficiency that are undergoing general anesthesia for permanent pacemaker implantation or another surgery unrelated to the heart such as cataract extraction or cystotomy.…”

“…3 The temporary pacing lead is usually a bipolar lead, although quadripolar electrophysiologic catheters are also available. Additionally, electrocardiography and, ideally, fluoroscopy are used to guide lead wire placement and identify ventricular capture.…”

The use of the diaphragmatico‐hepatic (DH) views of the abdominal and thoracic focused assessment with sonography for triage (AFAST/TFAST) examinations for the detection of pericardial effusion in 24 dogs (2011–2012)

“…The DH view, analogous to the subxiphoid view in human FAST exams, is advantageous over transthoracic views because the liver and gallbladder serve as acoustic windows into the thorax avoiding air interference from the lungs, which can be problematic for both novice and expert sonographers . Moreover, transthoracic air interference via the TFAST pericardial sites (similar to echocardiographic parasternal sites) is often further exaggerated when small animals are evaluated in sternal or standing position, commonly used during TFAST and by veterinary cardiologists because it is safer than lateral recumbency in respiratory distressed or compromised animals …”

Minimally Invasive Procedures

“…Surgical therapy for vascular obstructions can be technically challenging and dangerous, which is why interventional management options to remove or palliate the obstruction are gaining popularity. [44][45][46] Venous thrombi are primarily composed of fibrin and red blood cells and are generally considered secondary to stasis of blood flow or hypercoagulability. 44 Obstruction of the cranial vena cava (caval syndrome) can result from thrombi, heartworm disease, cranial mediastinal masses, and pacemaker leads.…”

“…Because arterial thromboembolic events are often emergencies that result in pain, ischemia, and tissue damage, antiplatelet drugs are of limited value for treatment of acute arterial thromboembolic events in veterinary patients. 44,46 Systemic urokinase, streptokinase, and tPA have been used with varying effectiveness in cats with aortic thromboembolism (ATE), in dogs with ATE, and in a femoral arterial obstruction in a dog. [58][59][60][61][62][63][64][65][66][67][68][69][70] Local administration of tPA in a cat with ATE and a Greyhound with ATE secondary to protein-losing nephropathy has been described, with both cases having return of motor function in their limbs and survival to discharge.…”